All posts by CHOC Children's

Leprosy antibiotic is safe treatment for M. abscessus infections, CHOC infectious disease team finds

An oral antibiotic used to treat leprosy is safe and well-tolerated in the treatment of children with challenging-to-treat mycobacterium abscessus infections, the CHOC Children’s infectious disease team has found.

In their study, clofazimine was given to 27 patients during an outbreak of odontogenic mycobacterial infections as part of a multidrug regimen. Though clofazimine performed well in test-tube experiments against M. abscessus, reports in children were previously limited.

This group of patients represents the highest number of children to receive clofazimine outside of leprosy treatment settings.

The study findings were published in the July 2019 Journal of the Pediatric Infectious Disease Society. Its authors are CHOC infectious disease specialists Dr. Felice Adler-Shohet; Dr. Jasjit Singh; Dr. Delma Nieves; Dr. Negar Ashouri; and Dr. Antonio Arrieta; as well as Cathy Flores, a CHOC clinical research nurse coordinator, and Tuan Tran, an infectious disease pharmacist at CHOC.

The patients who received the antibiotic were among a large group of children who underwent pulpotomy procedures at a dental practice with a contaminated water system.

CHOC’s team added clofazimine to its original first-line medication regimen after receiving special use approval from the Food and Drug Administration.

An additional benefit of use of clofazimine was the ability to stop use of an intravenous antibiotic given thrice daily that prompted many side effects, the team found.

Learn how to refer a patient to CHOC Children’s infectious disease specialists.

Breastfeeding resources to share with families

Breastfeeding offers extensive health benefits for moms and their babies, facilitates bonding and even has financial and environmental benefits. But with it comes challenges that—for some women—leads to an earlier end to breastfeeding than planned.

Below is a list of resources providers can share with breastfeeding patients to help ease worries and frustrations. These articles cover a range of concerns and provide helpful tips for both mom and baby.

Breastfeeding troubleshooting

The excitement of breastfeeding can quickly turn to frustration, discomfort or defeat if issues aren’t dealt with quickly. Encourage breastfeeding patients to get help from the experts, covered in this CHOC Children’s blog about lactation consultants and the CHOC Lactation Services team.

Spanish language breastfeeding resources

The CHOC Lactation Services team presents several useful flyers about breastfeeding for Spanish-speaking patients:

Breastfeeding and milk storage on-the-go

Managing milk when you are separated from your baby: a fact sheet for parents planning a little time away.

This piece from American Academy of Pediatrics (AAP) presents tips for an oft-dreaded scenario for new moms: nursing on an airplane. And with it comes another stressor, storing breast milk safely when flying.

For partners of breastfeeding women

AAP offers a fact sheet for partners of women who are breastfeeding.

What can others do to support a breastfeeding mom? Take a look at this CHOC Children’s blog for ideas.

Click here to learn more about Lactation Services at CHOC.

Four things pediatricians should know about juvenile arthritis

“Arthritis is something elderly people get,” is something Dr. Andrew Shulman, CHOC Children’s pediatric rheumatologist, has heard countless times. People are often surprised to learn that kids — even toddlers — can develop arthritis.

Joint pain can be a bit of a mystery to most people, especially when it comes to young children. With August being Juvenile Arthritis Awareness Month, we looked to Dr. Shulman to learn more about this and other common juvenile joint pain myths he finds most important for pediatricians to recognize and communicate with patients.

Myth 1: All joint pain is arthritis.

False. If joint pain is the primary symptom, chances are it is not arthritis. The most common initial symptoms of arthritis are persistent swelling, redness, stiffness and limited range of motion.

The type of joint pain that is associated with juvenile idiopathic arthritis (or JIA — formerly called juvenile rheumatoid arthritis) is pain in an articular location that is dull, throbbing or sharp and that improves throughout the day with movement. This pain is commonly exacerbated by prolonged sitting, naps and specific tasks, and improves with activity and non-steroidal anti-inflammatory drugs (NSAIDs). Sometimes skin redness is involved.

Myth 2: Arthritis is a precise diagnosis.

False. It is a symptom and a finding, much like a cough is not an official diagnosis. More testing is needed to determine whether or not joint pain is caused by a specific type of arthritis or another rheumatic condition, such as pain from overuse or a neuropathic disorder.

Myth 3: Arthritis is diagnosed with laboratory tests.

False. Labs can be used to characterize arthritis when it is present, but lab work can be totally normal in kids who do have arthritis. Using lab tests alone as a diagnostic tool can lead to a missed diagnosis.

Dr. Shulman urges pediatricians to keep in mind that routine lab work is more useful initially than specialized tests are. “A complete blood count (CBC) with differential, chemistry panel, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) tests present more information and are better initial screening tests than specialized tests such as antibody tests and complement studies,” he says.

Myth 4: Only elderly people get arthritis.

False. The incidence rate of JIA is one to 10 out of 10,000 per year, making it a more common condition among young people than cystic fibrosis, juvenile diabetes and muscular dystrophy combined.

Learn how to refer to a CHOC rheumatologist.

Talking to children after traumatic events: Six resources to share with families

Helping children cope through the aftermath of a traumatic event can be difficult.

Acts of mass violence, such as the recent shootings in El Paso and Dayton, bring up widespread worry, anxiety, uncertainty and trauma, and it can be overwhelming for parents to know where to start when talking to kids about it.

People often turn to healthcare providers for advice about the best ways to approach tough conversations with young people. The following is a list of helpful resources you can share with families about coping with the complicated feelings after a traumatic event.

Guidelines for helping youth after the recent shootings

This fact sheet by The National Child Traumatic Stress Network (NCTSN) offers guardians tips about helping children after an act of mass violence. It is presented in both English and Spanish versions.

For teens: coping after mass violence

Another NCTSN resource, this handout is tailored to parents of teens and includes information for adolescents on self-care after trauma.

American Psychological Association response to mass shootings in Texas, Ohio

American Psychological Association President Rosie Phillips Davis, PhD, offers an official statement, as well as a helpful list of resources, in the aftermath of mass gun violence.

How to help your child navigate the emotional aftermath of a traumatic event

This CHOC Children’s Blog post presents the five E’s, a clear series of steps parents and guardians can follow when talking to children, alongside a list of additional resources.

Talking to Children About Violence: Tips for Parents and Teachers

The National Association of School Psychologists offers points to emphasize when talking to kids of all ages about violence. Companion flyers are also offered in English, Spanish, Korean, Vietnamese, French, Amharic, Chinese, Portuguese, Somali, Arabic and Kurdish.

Should you talk to young children about tragic events?

This CHOC Children’s Blog post breaks down factors parents should consider before talking to their kid(s) about tragedy, including appropriate approaches by age group.

Immunization Roundup: Resources to share with families

August is National Immunization Awareness Month, an annual observance highlighting the importance of vaccinations in people of all ages.

The immunization schedule outlined by Centers for Disease Control & Prevention (CDC) and supported by the American Academy of Pediatrics (AAP) has been shown to be the most effective and safest way to protect children from potentially fatal diseases.

Nevertheless, many families lack knowledge about vaccines, especially due to the rise of misinformation on the internet.

The following is a collection of useful immunization resources—both for providers and for the families they serve—intended to encourage families to vaccinate and to quell worries brought on by vaccine myths.

General immunization references

Providers can direct families to these resources about the safety of and necessity for immunization in general.

Vaccines at a glance
This page that lays out the importance of vaccines, defines herd immunity and debunks common myths in a simple, reader-friendly way.

American Academy of Pediatrics 2019 Immunization Schedule
The CDC and AAP agreed-upon recommendations for immunizations for ages 18 and under, this resource clearly outlines timing of vaccines based by age, appropriate intervals for vaccine catch-up and special situations.

If you choose not to vaccinate your child, understand the risks and responsibilities
If parents decline recommended vaccines for their child, it is important to inform them that the decision creates major risks not only to their own child, but to every unvaccinated person they meet. This handout clearly defines the responsibilities that comes with this choice.

Condition-specific vaccine information to give to families

Diseases and vaccines that prevent them-for parents of infants and young children
This list breaks down vaccines by the conditions they prevent, including English and Spanish versions.

What vaccines does my teen need?        
Vaccines aren’t just important for babies. Teens need to be vaccinated too! Parents should be aware of vaccines that will benefit their adolescents.

The HPV vaccine: a pediatrician’s perspective
With all the talk of infant vaccinations, it’s easy to forget that some immunizations occur later in adolescence. This Kids Health blog outlines the important vaccines for teens, including meningococcus (MCV), human papillomavirus (HPV), tetanus, diphtheria and pertussis (Tdap) and others.

What parents should know about measles
Once labeled dormant in the US, measles are on the rise worldwide—most recently marked by a historically high number of cases in 2019. This Kids Health blog gives a thorough look at measles and the accompanying vaccine.

Vaccine talking points and tips for providers

American Academy of Pediatrics tips for talking to vaccine-hesitant parents
A resource for providers outlining best ways to approach parents who are hesitant to vaccinate—includes mythbusting, suggested approaches and strategies and a breakdown of types of parental attitudes toward immunizing.

Talking with parents about vaccines for infants
A guide to speaking with parents about vaccines, including common parental concerns and questions, communication strategies and suggested responses.

Presentation: 10 ways to create a culture of immunization within a pediatric practice
This CDC slide deck outlines ways hospitals can integrate accepted vaccine practices and incorporate all staff in the adoption of immunization culture.